Provider Demographics
NPI:1922756154
Name:MIRACLE CARE STAFFING, LLC
Entity Type:Organization
Organization Name:MIRACLE CARE STAFFING, LLC
Other - Org Name:MIRACLE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JATTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZONDO
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING ASSISTANT
Authorized Official - Phone:612-261-7295
Mailing Address - Street 1:204 JEFFERSON ST N
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1371
Mailing Address - Country:US
Mailing Address - Phone:612-261-7295
Mailing Address - Fax:218-216-0303
Practice Address - Street 1:204 JEFFERSON ST N
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1371
Practice Address - Country:US
Practice Address - Phone:612-261-7295
Practice Address - Fax:218-216-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health